老年患者全麻术后顺式阿曲库铵与罗库溴铵的残余作用比较

目的观察老年患者全麻术后顺式阿曲库铵与罗库溴铵的残余效应。方法择期全麻手术患者80例,随机分为罗库溴铵组(Ⅰ组)与顺式阿曲库铵组(Ⅱ组),每组40例。均采用静吸复合麻醉,术中采用四个成串刺激(TOF)监测肌松变化,术毕常规使用新斯的明拮抗。观察拔管即刻、麻醉后恢复室(PACU)的TOF值,记录应用拮抗剂到拔管、转入PACU的时间间隔及测量TOF值时的疼痛强度。结果Ⅰ组在拔管时TOFr<0.7和TOFr<0.9的残余肌松发生率分别为52.5%、87.5%,均高于Ⅱ组的45%和72.5%,但差异无统计学意义(P>0.05);两组患者在PACU的TOFr明显高于拔管即刻的TOFr,差异有统计学意义(P<0.05)。所有患者对测量TOF值时的疼痛强度VAS评分均<50mm。结论老年患者罗库溴铵的残余机松发生率高于顺式阿曲库铵,长时间手术可优先选择顺式阿曲库铵;对无新斯的明使用禁忌证的老年患者术毕应常规拮抗肌松,可减少术后残余肌松的发生。

Comparison of the residual effect of cisatracurium and rocuronium in aged patients after anesthesia

Objective To observe residual effect of cisatracurium and rocuronium after anesthesia in aged patients. Methods Eighty aged patients scheduled for anesthesia, with normal renal hepatic function and without muscle or nerves diseases were randomly divided into the rocuronium group (groupⅠ ) and cisatracurium group (groupⅡ), with 40 patients in each group. All the patients received sevoflurane 0.5%~3.5% inhalation during operation. Neuromuscular blockade was evaluated with train-of-four (TOF) stimuli of the ulnar nerve during operation. Neostigmine antagonist was used at the end of operation. The TOF rate (TOFr) of extubation, the post-anesthesia care unit (PACU), interval time from antagonist to extubation and to PACU, as well as the pain intensity of the TOF stimuli were recorded. Results In groupⅠ, the incidence of extubation residual neuromuscular blockade of TOFr<0.7 and TOFr<0.9 were 52.5%, 87.5%, respectively, slightly higher than 45.0% and 72.5% in group Ⅱ, with no statistically significant difference (P>0.05). The TOFr of the two groups in the PACU was significantly higher than that at the extubation (P <0.05). The pain intensity VAS scores of the TOF stimuli in all the patients were less than 50 mm (0~100 mm). Conclusion The incidence of residual neuromuscular blockade is higher with rocuronium than cisatracurium in aged patients. Cisatracurium is preferred for prolonged operation. For the patients with no neostigmine contraindications, antagonistic muscle relaxant should be performed to reduce the incidence of postoperative residual neuromuscular blockade.